Individual
ALYSSA IRENE FREDBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(651) 323-8334
Mailing address
2100 PARK AVE UNIT 682858, PARK CITY, UT 84068-4615
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
13455633-1206
UT
363A00000X
Physician Assistant
Primary
13455633-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018031454
EMT
UT
Enumeration date
08/10/2023
Last updated
03/04/2024
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